Access device having modular inserts and supporting accessories used in minimally invasive surgical procedures

ABSTRACT

A percutaneous access device for use in minimally invasive surgery includes an elongated body having a proximal portion and an opposing distal portion. The proximal portion has a proximal bore extending therethrough and the distal portion has a distal bore extending therethrough. The distal portion of the body is hingedly connected to the proximal portion in a first percutaneous access position and a second anchoring position. In the first percutaneous access position the distal and proximal bores are linearly aligned when a surgical instrument is inserted into both the proximal and distal bores. In the second anchoring position the distal bore is angularly displaced from the proximal bore when the surgical instrument is removed from the distal bore.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation-in-part of U.S. patent applicationSer. No. 15/098,301 filed on Apr. 13, 2016. This application claims thebenefit of and priority to U.S. Provisional Patent Application No.62/409,104, filed on Oct. 17, 2016, U.S. Provisional Patent ApplicationNo. 62/429,439, filed on Dec. 2, 2016, U.S. Provisional PatentApplication No. 62/467,593, filed on Mar. 6, 2017, U.S. ProvisionalPatent Application No. 62/467,596, filed on Mar. 6, 2017, and U.S.Provisional Patent Application No. 62/526,782, filed on Jun. 29, 2017,the disclosures of which are hereby incorporated by reference herein intheir entireties.

U.S. application Ser. No. 15/098,301 claims the benefit of and priorityto U.S. Provisional Patent Application No. 62/192,872, filed Jul. 15,2015, U.S. Provisional Patent Application No. 62/238,245, filed Oct. 7,2015, and U.S. Provisional Patent Application No. 62/277,427, filed Jan.11, 2016, the disclosures of which are hereby incorporated by referenceherein in their entireties.

BACKGROUND OF THE INVENTION 1. Field of the Invention

The subject invention is directed to surgery, and more particularly, toan anchored access port having an attachment to support accessories,such as imaging and lighting devices, used in minimally invasivesurgical procedures performed within the abdominal cavity of a patient,including, but not limited to, laparoscopic surgical procedures.

2. Description of Related Art

Laparoscopic or “minimally invasive” surgical techniques are becomingcommonplace in the performance of procedures such as cholecystectomies,appendectomies, hernia repair and nephrectomies. Benefits of suchprocedures include reduced trauma to the patient, reduced opportunityfor infection, and decreased recovery time. Such procedures within theabdominal (peritoneal) cavity are typically performed through a deviceknown as a trocar or cannula, which facilitates the introduction oflaparoscopic instruments into the abdominal cavity of a patient.

Additionally, such procedures commonly involve filling or “insufflating”the abdominal (peritoneal) cavity with a pressurized gas such as carbondioxide, to create what is referred to as a pneumoperitoneum. Theinsufflation can be carried out by a surgical access device (sometimesreferred to as a “cannula” or “trocar”) equipped to deliver insufflationgas, or by a separate insufflation device, such as an insufflation(veress) needle. Introduction of surgical instruments into thepneumoperitoneum without a substantial loss of insufflation gas isdesirable, in order to maintain the pneumoperitoneum.

During laparoscopic procedures, a surgeon makes three to four smallincisions, between 12 mm and 25 mm in length depending upon the devicetype, usually no larger than about twelve millimeters each, which aretypically made with the surgical access devices themselves, often usinga separate inserter or obturator placed therein. Following insertion,the inserter is removed, and the trocar allows access for instruments tobe inserted into the abdominal cavity. Typical trocars often providemeans to insufflate the abdominal cavity, so that the surgeon has anopen interior space in which to work.

The trocar must provide a means to maintain a desired pressure withinthe cavity by sealing between the trocar and the surgical instrumentbeing used, while still allowing at least a minimum freedom of movementof the surgical instruments. Such instruments can include, for example,scissors, linear staplers, grasping instruments, and occludinginstruments, cauterizing units, cameras, light sources and othersurgical instruments. Sealing elements or mechanisms are typicallyprovided on trocars to prevent the escape of insufflation gas. Sealingelements or mechanisms typically include a duckbill-type valve made of arelatively pliable material, to seal around an outer surface of surgicalinstruments passing through the trocar.

Anchoring means must also be provided for securing the trocar or cannulato a patient's abdominal wall during a procedure to prevent the accessdevice from inadvertently withdrawing from the incision through which ithas been extended. This is typically accomplished using sutures that arepassed through eyelets or similar tie-down features provided on thehousing of the trocar or cannula. However, the sutures that are used inthis manner can often cause increased trauma to the patient, addcomplexity to the surgical procedure and create obstructions near thesurgical site making it more difficult for the surgeon to operate.

In many of these surgical procedures, several access ports are required,each one dimensioned to receive a particular surgical instrument for useat the surgical site. One of the access ports is typically configured toreceive the endoscopic camera that is used for viewing the abdominalcavity and enabling display of the cavity and the manipulation of theinstrumentation and tissue within the body cavity on a video monitorviewed by the surgeon.

Percutaneous access devices allow for smaller instruments to be placedinto an operative field or space through smaller incisions than opensurgery.

It would be beneficial to have an anchoring device inside the operativespace during surgeries or interventions to decrease the incidence ofdevice withdrawal until the procedure/operation has been completed. Withan anchor in the operative space, it is not necessary to have resistancemodifications on the tube such as ribs, screws or textured surfaceswhich add resistance not only to removal but also to insertion. It wouldbe beneficial for the device insertion to be easier by decreasing thefriction coefficient of the percutaneous device and instead relying on amultifunctional boot tip anchor to prevent withdrawal.

Therefore, there is a need in the art for a surgical access device thatovercomes many of the disadvantages of prior art surgical accessdevices, including, among others, those associated with the use ofanchoring sutures to secure the access device in place during a surgicalprocedure. It would also be advantageous to reduce the number of accessports in the abdominal cavity while maintaining the same instrumentationand maneuverability of the instruments within the body cavity. Moreparticularly, it would be advantageous to incorporate certain accessorydevices, such as a camera, laser or light source into the access deviceitself, either integrally or by way of a modular attachment, in order toreduce the number of access ports employed during a surgical procedure.

SUMMARY OF THE INVENTION

The subject invention is directed to a new and useful surgicalpercutaneous access device and an access port for use in minimallyinvasive surgical procedures, such as, for example, laparoscopicsurgical procedures performed within a patient's abdominal cavity thatovercomes the disadvantages associated with prior art surgical accessdevices, including the use of anchoring sutures to secure the device inplace during a procedure.

In an embodiment of the subject invention a percutaneous access devicefor use in minimally invasive surgery is disclosed. The percutaneousaccess device includes an elongated body having a proximal portion andan opposing distal portion. The proximal portion has a proximal boreextending therethrough and the distal portion has a distal boreextending therethrough. The distal portion of the body is hingedlyconnected to the proximal portion in a first percutaneous accessposition and a second anchoring position. In the first percutaneousaccess position the distal and proximal bores are linearly aligned whena surgical instrument is inserted into both the proximal and distalbores. In the second anchoring position the distal bore is angularlydisplaced from the proximal bore when the surgical instrument is removedfrom the distal bore.

The distal portion of the body can include a shape memory materialconfigured to automatically hinge the distal portion from the firstposition to the second position when the at least one surgicalinstrument is slidably removed from the distal bore.

When the distal portion is in the second position, the proximal bore caninclude an open end configured to allow the at least one surgicalinstrument access to the interior of the patient's body. When the distalportion is in the first position the distal bore can be sealed by adistal tip. When the distal portion is in the second position, thedistal portion can be approximately ninety degrees with the body.

The percutaneous access device can include an instrument channel along aperimeter of the body from the proximal portion to the distal portionconfigured to accept a guidewire therethrough. The proximal portion ofthe body can include an O-ring seal configured to slideably engage withan outer surface of the body. The O-ring seal can be configured toprovide a barrier to advancement of the device through the patient'sbody when the seal reaches the skin surface. The O-ring seal can furtherinclude a sensor configured to measure the longitudinal advancement ofthe device within the patient's body.

The distal portion of the percutaneous access device can be adapted andconfigured to support one or more accessories used during a surgicalprocedure. The accessories associated with the distal portion can beselected from the group consisting of an optical imaging device, acamera device, a scope, a video device, a light source, a lightingdevice, a laser device, a measuring device, a laser measuring device, asignal transmitting device, a signal receiving device, a signalprocessing device, a memory storage device, a wiring device, a servodriven device, a gear device, an irrigation device, and/or a suctiondevice. A power source can be electronically coupled to a cableextending along the body to the distal portion configured to providepower to the one more accessories.

In another embodiment, an access port for use in minimally invasivesurgical procedure performed within a patient's abdominal cavity isshown and described. The access port includes a body defining a boreconfigured to guide at least one surgical instrument into a patient'sabdominal cavity. A first anchoring portion is integrally formed withthe body. An imaging system is coupled to the body. The imaging systemis integrated with a local positioning system and an operativepositioning system to communicate three dimensional positions and viewsof components utilized in during the surgical procedure.

The imaging system can be attached to the access port by a removableauxiliary module. The removable auxiliary module can be integrallycoupled to the body of the access port which contains instruments,mechanical channels, control servos power cables, connectors andcomputer equipment to operate and communicate with a removableinstrument module and modular anchor tip devices.

The body can include a coupling device configured to allow the body tobe controlled independently of other functions performed through thebore or from the auxiliary module.

The imaging system can include one or more cameras remotely controlled,the one or more cameras configured to continuously view a threedimensional grid surrounding the access port. The three dimensional gridviewed by the one or more cameras can be translated to create aholographic image of the operative field. The imaging system can furtherinclude imaging devices and position sensors located in one or morepositions in the operating room. The three dimensional grid can beconfigured to be recorded into a central data storage supportingartificial intelligence to produce independent camera movement based onposition sensor utilization positions and the corresponding cameraposition. The optical system can be activated when a surgical instrumentis placed through the access port.

In an embodiment, an access port for use in minimally invasive surgicalprocedure performed within a patient's abdominal cavity includes a bodydefining a bore configured to guide at least one surgical instrumentinto a patient's abdominal cavity. At least one anchoring portionintegrally formed with the body wherein the anchoring portion includesat least one imaging device.

The anchoring portion can include a transparent shield configured toprotect the first anchoring portion during and after insertion of theaccess port within the patient's abdominal cavity. The transparentshield includes a multi-layer structure monolithically formed with theanchoring portion.

In certain embodiments a kit for use in minimally invasive surgicalprocedures performed within a patient's abdominal cavity is shown anddescribed. An access port has a body defining a bore configured to guideat least one surgical instrument into a patient's abdominal cavity and afirst anchoring portion integrally formed with the body. A secondanchoring portion is configured for detachable coupling with the firstanchoring portion and articulating movement within the abdominal cavityrelative to the body.

The second anchoring portion can include a fixed segment and at leastone mobile segment. The at least one mobile segment can be configuredfor operative association with a control device outside of the patient'sabdominal cavity. The second anchoring portion can include one or moreposition sensors configured to electronically communicate with a localpositioning system.

A port extension adapter can have a proximal end defining an inlet, anda distal end configured for detachable engagement with the body of theaccess port, the distal end of the port extension adapter defining anoutlet configured to fluidly couple to a proximal end of the bore of theaccess port.

In another certain embodiment a kit for use in minimally invasivesurgical procedures performed within a patient's abdominal cavityincludes a body defining a solid structure and a first anchoring portionintegrally formed with the body. A second anchoring portion isconfigured for detachable coupling with the first anchoring portion andarticulating movement within the abdominal cavity relative to the body.

These and other features of the surgical access port of the subjectinvention and the manner in which both are manufactured and employedwill become more readily apparent to those having ordinary skill in theart from the following enabling description of the preferred embodimentsof the subject invention taken in conjunction with the several drawingsdescribed below.

BRIEF DESCRIPTION OF THE DRAWINGS

So that those skilled in the art to which the surgical access port ofthe subject invention appertains will readily understand how to make anduse the subject invention without undue experimentation, preferredembodiments thereof will be described in detail herein below withreference to certain figures, wherein:

FIG. 1 is a perspective view of a percutaneous access device of thesubject invention inserted into an incision in an abdominal wall of apatient, an anchored access port is simultaneously inserted near thepercutaneous access device for a minimally invasive surgical procedure;

FIG. 2 is an exploded perspective view of the percutaneous access deviceof FIG. 1, showing a distal portion angularly displaced from a proximalportion;

FIG. 3 is a cross-sectional view of the proximal portion of thepercutaneous access device;

FIG. 4 is a cross-sectional view of the distal portion of thepercutaneous access device;

FIG. 5 is a perspective view of a minimally invasive surgical procedureusing both the percutaneous access device and access port, being usedwith at least one surgical instrument inserted through each;

FIG. 6 is a perspective view of another minimally invasive surgicalprocedure using more than one percutaneous access device along with theaccess port;

FIG. 7 is a perspective view of the surgical procedure shown in FIG. 6,showing a surgical instrument through at least one of the percutaneousaccess devices;

FIG. 8 is schematic illustration showing an engaged system when a localpositioning system and operative system are aligned;

FIG. 9 is schematic illustration showing a disengaged system when thelocal positioning system and operative system are not aligned;

FIG. 10 is a perspective view of the percutaneous access device and theaccess port during a minimally invasive surgical procedure, showing athree dimensional grid surrounding the access port and a removableauxiliary module;

FIG. 11 is a detailed view of the removable auxiliary module of FIG. 10,showing the connection between the module and the access port;

FIG. 12 is a perspective view of an embodiment of an access port with anexemplary multi-segment boot tip in an assembled closed position andoriented for insertion into an incision in the abdominal wall;

FIG. 13 is a perspective view of the access port and multi-segment boottip of FIG. 12 in an open position, and installed in the abdominalcavity of a patient; and

FIG. 14 is a perspective view of another embodiment of the access portand multi-segment boot tip module of the subject invention in an openposition wherein a body portion of the access port is a solid structure.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

Referring now to the drawings wherein like reference numerals identifysimilar structural features or aspects of the subject invention, thereis illustrated in FIG. 1 a new and useful surgical percutaneous accessdevice 100 and an access port 200 for use in minimally invasive surgicalprocedures, such as, for example, laparoscopic surgical proceduresperformed within a patient's abdominal cavity.

Surgical access port 200 provides certain improvements over theadvantageous surgical access port devices disclosed in commonly assignedU.S. Pat. No. 9,011,319 to Norton et al., U.S. Patent ApplicationPublication No. 2007/0208312 to Norton et al., U.S. Patent ApplicationPublication No. 2015/0216562 to Norton et al., and U.S. ProvisionalPatent Application No. 60/779,136 to Norton, the disclosures of whichare hereby incorporated by reference herein in their entireties.Surgical access port 200 also provides certain improvements overadvantageous surgical access port devices disclosed in relatedInternational Patent Publication No. WO 2009/128811 to Norton et al.,U.S. Provisional Patent Application No. 61/124,066 to Norton et al.,U.S. Provisional Patent Application No. 60/965,404 to Norton et al., andU.S. Provisional Patent Application No. 60/961,802 to Norton et al., thedisclosures of which are hereby incorporated by reference herein intheir entireties. These improvements relate at least in part to theincreased modularity of the access port, adapting it for use in avariety of different surgical procedures, as will be discussed in moredetail herein below.

Referring now to FIG. 1, an exemplary minimally invasive laparoscopicprocedure 10 is shown with four incisions, P1, P2, P3, P4 within apatient's abdominal wall 12, surrounding the patient's liver and gallbladder. As shown, each incision accepts an anchoring device for examplea percutaneous access device 100 or an access port 200. With referenceto FIGS. 1 and 2, the percutaneous access device is shown in moredetail. The percutaneous access device 100 includes an elongated body102 with a proximal portion 104 and an opposing distal portion 106. Thebody 102 narrowly tapers from the proximal portion 104 to the distalportion 106 such that a diameter of the distal portion 106 is smallerthan a diameter of the proximal portion 104.

The proximal portion 104 has a proximal bore 104 a extendingtherethrough. Similarly, the distal portion 106 has a distal bore 106 aextending therethrough. The proximal and distal bores 104 a, 106 a aredesigned and configured to allow a surgical instrument 108, for example,an obturator through the body 102 of the device 100. The proximalportion 104 may include a seal 105 of appropriate size for the diameterof the proximal portion 104 surrounding the surgical instrument 108.

With continued referenced to FIG. 2, the distal portion 106 hingedlyconnects to the proximal portion 104. In other words, the distal portion106 hinges between a first percutaneous access position (shown inFIG. 1) and a second anchoring position (shown in FIG. 2). In the firstpercutaneous access position the proximal and distal bores 104 a, 106 aare linearly aligned along an axis A of the body 102 when the surgicalinstrument 108 is inserted into both the proximal and distal bores 104a, 106 a. In the second anchoring position, the distal bore 106 a isangularly displaced from the proximal bore 104 when the surgicalinstrument 108 is removed from the distal bore 106 a.

In order to hinge between the first percutaneous access position and thesecond anchoring position, a shape memory material 110 is positionedalong an outer surface 112 of the elongated body 102. As shown in FIG.2, the shape memory material 110 can extend along a portion of theproximal and distal portions 104, 106, however any similar configurationthat allows the distal portion 106 to be angularly displaced iscontemplated.

The shape memory material 110 allows the distal portion 106 to beangularly displaced from the proximal portion 104 once the surgicalinstrument 108 is removed from the distal bore 106 a. Preferably, theshape memory material 110 is flexible enough to assume a straightposition and strong enough to maintain the hinged position during thesurgical procedure. It is envisioned that the shape memory material 110is mechanically structured into the elongated body 102 or mechanicallyattached to the elongated body 102, as appropriate.

As best seen in FIG. 4, a horizontal cut or separation 118 extendsinwardly from the outer surface of the body 102 which allows the distalportion 106 to be angularly displaced. As best seen in FIG. 2, thedistal portion 106 includes a distal tip 106 b which seals thepercutaneous device 100. During a surgical procedure, the surgicalinstrument 108 is inserted into the proximal and distal bores 104 a, 106a thereby establishing the percutaneous device 100 in the firstpercutaneous access position. The percutaneous access device 100 maythen be inserted into one incision, for example P2.

Once the surgeon has inserted the percutaneous access device 100sufficiently into the patient's abdominal cavity, the surgeon slideablyreleases the distal portion 106 by pulling the surgical instrument 108proximally. In doing so, the distal portion 106 automatically hinges tothe second anchoring position due to the shape memory material 110. Ingeneral, the distal portion 106 is in a ninety degree angle with theproximal portion 104 when in the anchoring position. The surgeon canthen slide the surgical instrument 108 again distally towards andthrough an open end 104 b of the proximal bore 104 a (best shown in FIG.5) to access the interior of the abdominal cavity.

With reference to FIGS. 3 and 4, the percutaneous access device 100 canalso include an instrument channel 114 to accept a guidewire 116therethrough. The guidewire 116 can allow access to the operative spaceby visual or other forms of imaging/location identification. This wouldbe useful in accessing the calyx of the kidney for percutaneoustreatment of kidney stones or an abscess cavity.

The percutaneous access device 100 may further include an O-ring seal122 configured to provide a barrier to advancement of the device throughthe patient's body when the seal reaches the skin surface. The O-ringseal 122 is positioned around the body 102 of the percutaneous accessdevice 100. The seal 122 pray be of hardened material or of elastomericmaterial. It is envisioned that an inner diameter of the O-ring seal 122may be one of any diameter to engage the body 102 of the access device100. The inner diameter may in a central position or any eccentricpositioning as needed to adjust for form and function. An outer diameterof the O-ring is not limited to the shape of the device. For example,the shape of the outer diameter may be teardrop, oblong or any geometricshape. Alternative interior diameters may be of any shape that willaccommodate any external diameter or shape of the percutaneous accessdevice 100.

The O-ring seal 122 is designed to slideably engage with the outersurface 112 of the device 100. The percutaneous access device 100 has avariable enlarging diameter from the distal portion 106 to the proximalportion 104. As the O-ring seal 122 is moved proximally, the O-ring seal122 will reach a longitudinal position on the body 102 of the device 100where the seal 122 can no longer advance. In this manner, the O-ringseal further provides longitudinal stability to the device 100 which isimportant in obtaining precision measurements from the device 100 orsending and/or receiving precision measurements.

In certain embodiments, the O-ring seal 122 may have embedded orattached measuring devices, signal devices, location identifiers, GPS orBluetooth or other communication devices that allow the O-ring tointegrate into a local or remote system based on a communicationplatform.

In another embodiment, the O-ring seal 122 can have alocator/measuring/signal/sensor device 124 which would identify thelongitudinal location of the device 100. Likewise, the device mayinclude a locator/measuring/signal/sensor device along the longitudinaland or radial aspect of the device 100 identifying the longitudinal andradial coordinates of the device 100 such that the physical position canbe measured and identified in an integrated network. In this embodiment,each device 100 may include a unique identifier within an individualnetwork. Each device 100 may be connected by remote or direct wiring ora physically attached positioning system.

As best shown in FIG. 2, the distal portion 106 of the percutaneousaccess device 100 includes one or more accessories 130. For example, anadjustable light source on the distal end 106 would allow a variety oflighting solutions in the operative environment. Accessories 130 canalso include an optical imaging device, a camera device, a scope, avideo device, a light source, a lighting device, a laser device, ameasuring device, a laser measuring device, a signal transmittingdevice, a signal receiving device, a signal processing device, a memorystorage device, a wiring device, a servo driven device, a gear device,an irrigation device, and/or a suction device. A cable 125 extends alongthe body 102 from the distal end to an external power source (not shown)to provide power to the accessories.

Improved imaging could be obtained by providing a more uniform sourcingof light from variable locations. Alternatively, a variety of imagingdevices, measuring devices and energy sources could be used to obtaindata necessary to form alternative images, such as three dimensional orholographic images, as compared to images obtained from a single sourcesuch as a laparoscope.

With reference now to FIGS. 5-7, the percutaneous access 100 is shownused in conjunction with an access port 200 for a minimally invasivesurgical procedure. As illustrated, each incision P1, P2, P3, P4 canaccept either an access device 100 or access port 200. It will beunderstood that the configuration shown is for explanatory purposes andany configuration or number of access devices 100 and access ports 200can be used without distracting from the scope of the invention.

The access port 200 includes a body 202 defining a bore 204 configuredto guide at least one surgical instrument 109 into a patient's abdominalcavity. The access port 200 can include more than one bore 204, as shownin FIG. 5, or the access port 220 can include one bore 204, as shown inFIG. 6. In other embodiments, the access port 300 (shown in FIG. 14) maybe a solid structure used for lighting and visual accessories, as willbe discussed in further detail below.

Regardless of the number of bores, the body 202 of the access port 200has a proximal end portion 206 and an opposing distal end portion 208.Several embodiments of the access port are shown and described infurther detail in U.S. Patent Publication 2017/0014155 to Norton et al.,the disclosure of which is incorporated herein in its entirety.

The proximal end portion 206 includes a first anchoring portion 210integrally formed with the body 202. The first anchoring portion 210 isgenerally a concave shape to secure the access port 200 along theabdominal wall 12. The distal end portion 208 includes a secondanchoring portion 212 (shown in FIG. 6) which is generally a convexshape projecting radially outwardly from the distal end portion 208 ofthe body 202 for securing the access port with respect to the interioror the abdominal wall.

As best seen in FIG. 5, the distal end portion 208 can include a lightmodule 214 which can provide an additional lighting source to theinterior abdominal cavity. In addition, the light module 214 can providea location for one or more cameras, and/or measuring and communicationdevices. With reference to FIGS. 6 and 7, three percutaneous accessdevices 100 and one access port 200 are inserted into the abdominal wall12 to work in conjunction on the surgical procedure. FIG. 7 also shows avarying use/embodiment of the guidewire placement/location. In thisembodiment, the guidewire 116 can be inserted through the proximal bore104 and into the abdominal cavity to effect a desired treatment.

Referring now to FIGS. 8-11, an imaging system is coupled to the body ofthe access port wherein the imaging system can be integrated with alocal positioning system and an operative position system to communicatea three dimensional view during a surgical procedure and capture thepositioning of the access port 200. The imaging system can include aremovable auxiliary module 234 coupled the access port 230 and aplurality of cameras and/or sensors 236 on the distal portion 208 of theaccess port 230. Preferably, the imaging system can be controlledremotely, manually or by robotics. Cameras 236 of the imaging system mayrotate or extend as needed. It is envisioned that the imaging system canalso move or include a movable portion which can move either remotely orby robotics.

As best seen in FIGS. 10 and 11, the removable auxiliary module 234provides an expandable platform for the addition of equipment or toarrange the equipment in the most effective use of space. The modularconstruction of the removable auxiliary module 234 may contain reusableelectronics and systems enhancing cost effectiveness. The removableauxiliary module 234 can also contain instruments, mechanical channels,control servos power cables, connectors and computer equipment.

The local positioning system can be a computer related medium, system orprogram code that captures, integrates and translates a threedimensional grid surrounding the access port 200. The local positioningsystem can incorporate the views from the imaging system along with dataand views from sensors and cameras located in one or more positions inthe operating room to achieve a full view of the surgical field. Forexample, sensor 124 of the seal 122 may be tied into the local positionsystem. In addition, at least one sensor 205 can be located on accessport 220 or at least one sensor 105 can be located on the percutaneousaccess device 100 which provide positioning information during thesurgical procedure. Sensors and imaging devices are shown on the accessdevices or surgical accessories, however, it will be understood thatadditional sensors can be located outside the abdominal cavity toprovide additional positioning information and view of the operativefield.

The operative positioning system communicates the location, position andangle of the access port 200 during the surgical procedure. Theoperative positioning system consists of measurable points, such assensor 205 on access port 220. It is envisioned that other measuringpoints can be placed on the organ of interest or be integrated withlaser point measuring originating from the percutaneous access device100.

With continued reference to FIG. 10 a three dimensional grid 240 isoutlined surrounding the access port 220 representing the field of viewcaptured by imaging devices of the imaging system, for example, imagingdevices on or within the removable auxiliary module 234 and accessories236. Views from the imaging devices and the three dimension grid 240 canbe translated and viewed on an external monitor to assist the surgeonduring the procedure. In other embodiments, the views captured withinthe grid can be reconstructed into two dimensional, three dimensionalimages or a holographic image of the operative field.

The operative system allows for the exact position and/or displacementof the access port 200 to be recognized in real-time. For example,unintentional pressure within the abdominal cavity may shift the angleof the access port 200. The operative system can include a notificationsignal that alerts the surgical team to any and all displacement of theaccess port 200. A coupling device (not shown) may then be used on edges242 (shown in FIG. 11) of access port 230 to adjust the displacement ofthe access port 230 to keep the access port 230 and surgical instrument,for example, 108, therein aligned as needed. The coupling device can beused to adjust and reposition the access port 230 thereby controllingthe body of the access port independent of the surgical instrument andfunctions being performed during the surgical procedure.

The operative system is activated when a surgical instrument is placedthrough the bore 204 of the access port 200. Ideally, once the operativesystem is activated the operative system and the local positioningsystem are engaged and focused on the same focal point. Having bothsystems focus on single target increases the range of the target.

As shown in FIG. 8, an engaged system is shown wherein the focal point310 overlaps the field of view of the access port 312 and the localpositioning system 314. An engaged system is analogous to holding one'shead and neck in a fixed position and tracking the focal point 310 withone's eye. Having both systems focus on a single target increases therange of view of the target. Therefore, regardless of any movement orrotation of the imaging devices the focal point 310 remains the same.

However, due to the surgical procedure or unintentional movement, thesynchronization between the operative system and local positioningsystem can become disengaged, as shown in FIG. 9. In this scenario thefocal point of the access port 312 is now at reference 320 whereas thefocal point of the local positioning system is now at 330. A disengagedsystem is analogous to looking to a new focal point for optical viewingas one moves one's head or neck to reposition one's eyes to look at thechosen focal point. When the systems are disengaged adjustments areneeded either to the access port or direction of the imaging andlighting features to reengage the system.

It is envisioned that the imaging system, local positioning system andoperative system can be coupled together by direct mechanicalconnection, direct electrical connection, Bluetooth, Wi-Fi or otherelectronic communication devices. Integrating the systems with computergraphic systems and robotic systems provides several advantages, forexample, auto correction of imaging during motion of the modular imagingdevice/devices; two dimensional, three dimensional and holographic imagereconstruction using computer graphic systems; accurate data forutilization of monocular, binocular, telephoto, and multiple cameraimage synthesis to guide surgical intervention; and coordination ofsupport systems for retraction, electromechanical surgical instruments,measuring and communication devices for surgery.

With reference now to FIGS. 12 and 13, another embodiment of an accessport 250 is shown. In this embodiment, the access port 250 includes onebore 254 and first and second anchoring portions 256, 258. The firstanchoring portion 256 is integrally formed with the body 252 and issimilar in configuration to first anchoring portion 210. The secondanchoring portion 258 is an operative platform configured for detachablecoupling and articulating movement within the abdominal cavity.

As best seen in FIG. 13, the second anchoring portion 258 can include atleast one fixed segment 262 and at least one mobile segment 264. Duringinsertion of the access port 250, the mobile segment 264 may be stowablewithin the interior volume of the second anchoring portion 258.

The fixed segment 262 can include one or more imaging devices and/orlighting devices 268 which can be electronically coupled and remotecontrolled. The imaging devices 268 may aid in confirming the properinsertion of the access port 250 both during and after insertion. Aspreviously discussed, the imagining and/or lighting devices 268 can beintegrated to the local positioning system to give positioning,location, lighting and additional views of the operative site.

In addition, a multi-layer monolithically formed transparent shield 266can be formed along either the fixed or mobile segments 262, 264 toprotect the second anchoring portion 258 during and after insertion ofthe access port 250 within the abdominal cavity. The shield 266 may beintegrated or separate or be present in one or more layers. For example,one layer to protect during insertion and/or one layer to protect acamera lens 268 after deployment. The shield 266 may be integrated witha tip 262 a of the fixed segment 262. The shield 266 may also be aseparate functioning independent accessory.

The shield 266 may be flexible, retractable or dissolvable. In aseparate embodiment, the shield 266 may also be bifid allowing forprotection of an optical accessory during insertion yet retracted awayfrom the optical accessory during deployment of the access port 250.

The shield 266 may include a single polymer or a plurality laminatedpolymers or connected layers each of which may be coated separately orin combination with hydrophobic coating to disperse moisture orhydrophilic material to absorb moisture. Micro etching may be utilizedto decrease fogging and disperse microscopic and small collections ofmoisture on the optical shield. These same techniques may be used as alens protector for a separate integrated or accessory camera attached orinserted with the anchor tip device.

The second anchoring portion 258 may further be temperature adjusted bya separate accessory which may be inserted into the internal spaceallowing flow of a gas or liquid into the interior space. The purpose isto decrease the moisture deposition on any surface or of the anchor tipitself whither it is interior or exterior. The temperature regulated gasor fluid may be directed to one or more integrated or modular accessorycameras and it may be directed between connected layers of an opticalshield to inhibit moisture, moisture collection, fogging and to dispersemoisture or fog.

The mobile segment 264 may be in a protective housing or may be adjacentand parallel to the fixed segment 262 during insertion. The mobilesegment 264 may have a variety of instruments attached to it which mayvary according to the procedure being performed. The instruments mayembody similar functional formats or may include a variety of movementmechanisms to position and optimize location for the proposed procedureand instrument function. The mobile segment 264 may carry one or moreinstruments, lighting, or measuring devices that aid in performing adesired effect of the procedure.

In one embodiment the mobile segment 264 can include an imaging deviceand be mounted on the distal aspect of a telescoping assembly 276 thatis extendable and controllable with an external device by direct controlwhether it is through direct mechanical, electrical or wireless control.The mobile segment 264 can have the ability to articulate or bend tocompliment the requirements of a procedure.

The mobile segment 264 and the body 252 of the access port 250 can eachinclude one or more sensors 272 and 274 which electronically communicatewith an external system. For example, sensor 272 of the mobile segment264 can transfer position information and be electronically coupled toan external control device to move or adjust position as needed.Further, sensors 272, 274 can couple to the local positioning system,described above, to provide additional imaging and location views.

The data received into the local positioning system from the mobilesegment 264 may be serially collated as a series of movements andpositions needed to accomplish a specific task. The serial collection ofdata collected can be collated with other measured data and structuredin a layered data point matrix from whereby the required articulatinginstrument position sequence can be derived from the data. Real timeinstrument positioning collected from one or more instruments or portscan be communicated to a coordinate measuring machine which in turncommunicates with the controller of the articulating accessory arm tomove to the predicted position as analyzed and communicated by the threedimensional grid.

Referring now to FIG. 14, an alternate embodiment of access port 280 isshown wherein the body 282 is a solid device without additional bores.The remaining features of the access port are similar to access port 250with first and second anchoring portions, 286 and 288. The secondanchoring portion including at least one fixed segment 282 and a mobilesegment 284.

It will be appreciated that alternative embodiments of modular anchoringdevices and the attachment mechanisms between the modular anchoringdevices and the bodies of the access devices can be utilized, including,for example, ball and socket joints, mortise and tenon, and male andfemale pin and receiver. Such joints may be configured in sequence or inparallel as may be required to adapt to particular operativeenvironments. In certain embodiments, one of the boot tip shapedanchoring segments/arms/tips may h fixed in position with one or moreadditional segments which are mobile such that the fixed segmentprovides primary support and anchoring to the mobile segments. Themobile segments may attach to the fixed segment, or may be directlyattached to the body of the access device. The body of the access devicemay be provided in other shapes, and is not limited to conical ortruncated conical shapes, if different shapes are more effective to meetrequirements of a particular operation and operative field. The mobilesegments (e.g., mobile arms) can be motorized from within.Alternatively, the fixed segments may function as a primary housing formechanical and controller devices with the mobile segments functioningin, for example, various of the other capacities listed above. Themobile segments may be controlled by direct control, remote control,first person vision, GPS motion, voice or ocular control, measuringdevices, or programmed integrated/coordinated movements.

Alternatively, the primary anchoring segment may be mobile andconfigured to provide an adjustable (simple or compound) angle, thusproviding dynamic positioning adaptable to changing requirements as theoperation progresses. The body of the access device may additionallyprovide workspace housing, equipment mounting, and one or more conduitsfor wiring, fiberoptics, batteries, lighting, cameras or monitoringsensors in addition to any other devices needed to support the abovedescribed components and systems.

It will be appreciated that the embodiments of the inventive disclosuredescribed herein allow for entry into the abdominal cavity through asingle access device in a single incision, modularity both inside theaccess device body (e.g., with detachable seals and inserts which canfluidly couple and fluidly isolate one or more bores of the accessdevice to/from one or more fluid channels defined by the detachableinsert), and outside the access device body (e.g., with detachableanchoring portions and sleeves as described herein). The above describedembodiments allow the surgeon to spread outward within the abdominalcavity from one or more ports of the access device, in a variable yetcontrolled manner while supporting surgical accessories adjacent thebody of the access device.

While the subject invention has been shown and described with referenceto preferred embodiments, those skilled in the art will readilyappreciate that various changes and/or modifications may be made theretowithout departing from the spirit and scope of the subject invention asdefined by the appended claims.

What is claimed is:
 1. A percutaneous access device for use in minimallyinvasive surgery, comprising: an elongated body having a proximalportion and an opposing distal portion, the proximal portion having aproximal bore extending therethrough and the distal portion having adistal bore extending therethrough, wherein the distal portion of theelongated body is hingedly connected to the proximal portion in a firstpercutaneous access position in which the distal and proximal bores arelinearly aligned along an axis of the elongated body when at least onesurgical instrument is inserted into both the proximal and distal boresand a second anchoring position in which the entire distal bore isangularly displaced to a side from the proximal bore when the at leastone surgical instrument is removed from the distal portion, wherein theproximal portion of the elongated body includes an O-ring sealconfigured to slideably engage with an outer surface of the elongatedbody.
 2. The access device of claim 1, wherein the distal portion of theelongated body includes shape memory material configured toautomatically hinge the distal portion from the first position to thesecond position when the at least one surgical instrument is slidablyremoved from the distal bore.
 3. The access device of claim 1, whereinwhen the distal portion is in the second position, the proximal boreincludes an open end configured to allow the at least one surgicalinstrument access to the interior of the patient's body.
 4. The accessdevice of claim 1, wherein when the distal portion in the first positionthe distal bore is sealed by a distal tip.
 5. The access device of claim1, wherein when the distal portion is in the second position, the distalportion is oriented at an angle of approximately ninety degrees withrespect to the elongated body.
 6. The access device of claim 1, furthercomprising an instrument channel extending along a perimeter of theelongated body from a proximal end thereof to a distal end thereof,which is configured to accept a guidewire therethrough.
 7. The accessdevice of claim 1, wherein the O-ring seal is configured to provide abarrier to advancement of the device through the patient's body when theseal reaches the skin surface.
 8. The access device of claim 1, whereinthe O-ring seal includes a sensor configured to measure the longitudinaladvancement of the device within the patient's body.
 9. The accessdevice of claim 1, wherein the distal portion is adapted and configuredto support one or more accessories used during a surgical procedure. 10.The access device of claim 9, wherein the accessories associated withthe distal portion are selected from the group consisting of an opticalimaging device, a camera device, a scope, a video device, a lightsource, a lighting device, a laser device, a measuring device, a lasermeasuring device, a signal transmitting device, a signal receivingdevice, a signal processing device, a memory storage device, a wiringdevice, a servo driven device, a gear device, an irrigation device,and/or a suction device.
 11. The access device of claim 9, furthercomprising a power source electronically coupled to a cable extendingalong the elongated body to the distal portion configured to providepower to the one or more accessories.
 12. A percutaneous access devicefor use in minimally invasive surgery, comprising: an elongated bodyhaving a proximal portion and an opposing distal portion, the proximalportion having a proximal bore extending therethrough and the distalportion having a distal bore extending therethrough, wherein the distalportion of the elongated body is hingedly connected to the proximalportion in a first percutaneous access position in which the distal andproximal bores are linearly aligned along an axis of the elongated bodywhen at least one surgical instrument is inserted into both the proximaland distal bores and a second anchoring position in which the entiredistal bore is angularly displaced to a side from the proximal bore whenat least one surgical instrument is removed from the distal bore, andwherein when the distal portion is in the first position the distal boreis sealed by a distal tip and wherein when the distal portion is in thesecond position the proximal bore includes an open end allowing the atleast one surgical instrument access to the interior of the patient'sbody, and wherein the proximal portion of the elongated body includes anO-ring seal configured to be slideably engaged with an outer surface ofthe elongated body.
 13. The access device of claim 12, wherein thedistal portion of the elongated body includes shape memory materialconfigured to automatically hinge the distal portion from the firstposition to the second position when the at least one surgicalinstrument is slidably removed from the distal bore.
 14. The accessdevice of claim 12, wherein the distal portion is adapted and configuredto support one or more accessories used during a surgical procedure. 15.The access device of claim 12, further comprising an instrument channelalong a perimeter of the elongated body from the proximal portion to thedistal portion configured to accept a guidewire therethrough.